The goal of this postdoctoral fellowship will be to facilitate the candidate's development as a leader in health services research with a focus on process and system redesign improvements in emergent care delivery. Building on her background in emergency medicine, business administration, and health services research, the candidate proposes to develop additional skills during the award period through (1) coursework designed to expand her methodological skills, (2) interaction with a multidisciplinary team of sponsors and collaborators, and (3) a series of supervised research projects. The overall objective of these projects is to utilize innovative risk assessment techniques to identify factors in the system and processes of care that contribute to variations in compliance with the Sepsis Resuscitation Bundle, across three hospital emergency departments. This will be accomplished through two specific aims: (1) to conduct a comprehensive multi-disciplinary risk assessment that includes (1.1) a retrospective analysis of the relationship between ED organizational and operational characteristics and Sepsis Resuscitation Bundle compliance, (1.2) and proactive risk assessments using failure mode effects and criticality analysis, of severe sepsis resuscitation across three institutions, and (1.3) a retrospective analysis of recordings of in situ severe sepsis simulations and debriefings, and (2) identify the most critical and generalizable risks in the systems and processes of care involved in the delivery of ED severe sepsis resuscitation through aggregating and ranking the risks across institutions. This project will meet the mission of the Agency for Healthcare Quality and Research by identifying factors to improve the safety and quality of severe sepsis care through promoting the delivery of appropriate care that achieves the best quality outcomes. The project, along with the chosen coursework and mentorship, will allow the candidate to become more proficient at qualitative and statistical methodology. Towards the end of the award period, the candidate plans to submit a career development award using the results of the project to develop generalizable process and system redesign interventions to improve care delivery of severe sepsis resuscitation across institutions. PUBLIC HEALTH RELEVANCE: Severe sepsis is a time-sensitive, high mortality disease state for which therapies exist that may significantly reduce mortality, but these therapies are not applied consistently across hospitals. This project will benefit public health by identifying factors that contribute to variations in severe sepsis resuscitation across hospital emergency departments and critical areas for improvement in the processes of severe sepsis resuscitation care to inform future process and system redesign interventions. Improving care delivery for this high cost, high morbidity and mortality condition has the potential to significantly improve the safety and quality of care and result in lives saved, reduced healthcare costs, and improved equity of care.